Health Connector clears backlog

BOSTON -- Having cleared a backlog of paper health insurance applications, the beleaguered state Health Connector Authority is turning its attention to determining the number of people earning too much to qualify for Medicaid but who were placed into the publicly-funded program to ensure their coverage in the face of a non-functioning website.

"No surprise. The first population listed here is the population that is over four times the poverty level in temporary Medicaid coverage. Again, number one, we don't know how many that is," Secretary of Administration and Finance Glen Shor told the Connector Board on Thursday. He said, "Insofar as we identify this population, sooner rather than later, we have a mechanism to move them."

The state's health exchange website has been beset with problems since its October launch, leading to a backlog of paper applications and a growing number of people receiving temporary Medicaid coverage. Officials believe most of those people would have qualified for subsidies.

"In the fall there was a decision made to prioritize getting anyone who applied for subsidized coverage access to health care. And at that point we never imagined we would be in the position we are in now in terms of still relying on that transitional, that temporary Medicaid coverage to provide folks that access to health care," Sarah Iselin, a special assistant to Gov. Deval Patrick working to right the Health Connector, told reporters.

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"Because we were prioritizing coverage, we just were not able to put in place normal processes that we do around income verification."

Clearing a backlog of paper applications has allowed state consultants Optum and others to focus on determining eligibility and transitioning people off temporary Medicaid. The backlog stood at 72,000 applications in February. Connector staff along with hundreds of workers have worked through the backlog as new applications rolled in, getting it down to a manageable level over the past week.

Those earning 400 percent of the federal poverty level - which would be $46,680 annually for a single person - do not qualify for any subsidies. Though consultants don't expect the health exchange to be fully functional until the fall, it has the complete capability to handle shopping for people seeking unsubsidized coverage, according to Shor. Though there is a - recently extended - open enrollment deadline of April 15 for unsubsidized plans, those who are moved off Medicaid would qualify to purchase a plan outside the open enrollment period, Shor said.

Aside from those earning 400 percent above poverty level, the state has additional groups that it plans to "focus on and expedite migration to right coverage."

While the federal government will reimburse the state by 50 percent for many of the people in temporary Medicaid coverage, the state will have to cover all the medical claims of anyone in the temporary coverage who earns 400 percent of the federal poverty level or more. Shor noted that unless a claim is made, the state would not pay anything.

The total number of people in temporary Medicaid coverage is about 125,000, and officials believe most of those people will ultimately qualify for Medicaid or subsidized coverage.

"What we know is that the majority of the uninsured population in Massachusetts is low income, and we only have 3 percent uninsured in this population overall, so we feel confident when we look at that now 125,000 people who are in temporary Medicaid coverage, that they are predominantly low-income," Iselin said. She said, "However it is possible, and that's why we've prioritized the identification of those over 400 [percent], that it's possible there was a few [that] kind of got into the program in that early period because we were prioritizing coverage."

Iselin said she is "confident that we are designing systems and processes in the near-term - so we're not going to wait for that functional website that will be available in the fall - to move them out and support them buying health coverage."

Those who would qualify for Medicaid could receive a larger federal reimbursement after they are moved out of the temporary coverage, Shor said. Shor said there has been about $7 million in claims through early March for individuals in temporary coverage, though the cost to the state will depend on whether people qualify for various programs.

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